Abstract

Objectives To measure the effectiveness and cost effectiveness
of providing care in a chest pain observation unit compared
with routine care for patients with acute, undifferentiated chest
pain.
Design Cluster randomised controlled trial, with 442 days
randomised to the chest pain observation unit or routine care,
and cost effectiveness analysis from a health service costing
perspective.
Setting The emergency department at the Northern General
Hospital, Sheffield, United Kingdom.
Participants 972 patients with acute, undifferentiated chest
pain (479 attending on days when care was delivered in the
chest pain observation unit, 493 on days of routine care)
followed up until six months after initial attendance.
Main outcome measures The proportion of participants
admitted to hospital, the proportion with acute coronary
syndrome sent home inappropriately, major adverse cardiac
events over six months, health utility, hospital reattendance and
readmission, and costs per patient to the health service.
Results Use of a chest pain observation unit reduced the
proportion of patients admitted from 54% to 37% (difference
17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65,
P < 0.001) and the proportion discharged with acute coronary
syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates
of cardiac event were unchanged. Care in the chest pain
observation unit was associated with improved health utility
during follow up (0.0137 quality adjusted life years gained, 95%
confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of
£78 per patient (–£56 to £210, P = 0.252).
Conclusions Care in a chest pain observation unit can improve
outcomes and may reduce costs to the health service. It seems
to be more effective and more cost effective than routine care.